Showing papers in "Minimally Invasive Therapy & Allied Technologies in 2008"

Haptics in minimally invasive surgery – a review

Abstract: This article gives an overview of research performed in the field of haptic information feedback during minimally invasive surgery (MIS). Literature has been consulted from 1985 to present. The studies show that currently, haptic information feedback is rare, but promising, in MIS. Surgeons benefit from additional feedback about force information. When it comes to grasping forces and perceiving slip, little is known about the advantages additional haptic information can give to prevent tissue trauma during manipulation. Improvement of haptic perception through augmented haptic information feedback in MIS might be promising.

Robotic suturing: technique and benefit in advanced laparoscopic surgery.

Abstract: Suturing is one of the main tasks in advanced laparoscopic surgery, but limited degrees of freedom, 2D vision, fulcrum and pivoting effect make it difficult to perform. Robotic systems provide corresponding solutions as three-dimensional (3D) view, intuitive motion and additional degrees of freedom. This review evaluates these benefits for their impact on suturing in experimental and clinical studies. The Medline database was searched for "robot*, telemanipulat* and laparoscop*". A total of 1150 references were found and further limited to "suturing" for experimental evaluation, finding 89 references. All references were considered for information on robotic suturing in advanced laparoscopy. Further references were obtained through cross-referencing the bibliography cited in each work. In experimental studies current robotic systems have proven their superior suturing capabilities compared to conventional laparoscopic techniques, mainly attributed to 3D visualization and full seven degrees of freedom. In clinical studies these benefits have not yet been sufficiently reproduced. Robotic systems have to prove the benefits shown in experimental studies for suturing tasks in clinical applications. Robotic devices shorten the learning curve of laparoscopic procedures. Further clinical trials focusing on anastomosis time are needed to assess this question.

Stem cell labeling for magnetic resonance imaging

Abstract: In vivo applications of cells for the monitoring of their cell dynamics increasingly use non-invasive magnetic resonance imaging. This imaging modality allows in particular to follow the migrational activity of stem cells intended for cell therapy strategies. All these approaches require the prior labeling of the cells under investigation for excellent contrast against the host tissue background in the imaging modality. The present review discusses the various routes of cell labeling and describes the potential to observe both cell localization and their cell-specific function in vivo. Possibilities for labeling strategies, pros and cons of various contrast agents are pointed out while potential ambiguities or problems of labeling strategies are emphasized.

The OTSC clip for endoscopic organ closure in NOTES: device and technique.

Abstract: The closure of the gastrotomy in Natural Orifice Transluminal Endoscopic Surgery (NOTES) is a prerequisite for transgastric endoscopic procedures in the abdominal cavity. Different techniques have been proposed and are under experimental or early clinical investigation. We describe the technique of using an over-the-scope-clip system (OTSC), made of super-elastic Nitinol and a specially designed tissue-approximating double jaw endoscopic grasper for gastric closure. The OTSC is a clipping system mounted at the tip of the endoscope and is used for the treatment of gastrointestinal bleeding or gastrointestinal organ perforations. An enlarged version of the OTSC is now under investigation for NOTES. The closure procedure consists of two steps. First the margins of the perforation are approximated by means of an endoscopic grasper that has two mobile and one fixed jaw, thus providing two independent tissue grasping areas. Each half of this twin grasper is used to grasp one side of the perforation wound margins. Then the margins are approximated and pulled towards the OTSC cap at the tip of the scope. Then the clip is released and the access hole is closed by compression. The OTSC clip can be applied for organ closure in NOTES in experimental studies. The technique allows closing the access site from inside the gastric cavity without leaving material on the peritoneal surface of the organ.

The current evidence on stapled versus hand‐sewn anastomoses in the digestive tract

Abstract: The innovation process and developments in technology have given surgeons new products which can improve their performance and benefit our patients. Before the era of laparoscopic surgery one of the most important applications in surgical practice was the introduction of staplers. In this article, the evidence supporting the decision whether to use a mechanical device (stapler) or to make a hand-sewn anastomosis is presented. A sytematic review of the literature was performed. The search included published meta-anaylses, randomized clinical trials and comparative studies. Key words for the initial search were: surgical anastomosis, stapler, hand-sewn. There was no language restriction. The reference lists from the selected articles were also checked by the author. Literature data on main outcomes concerning the application of one or the other surgical technique have been analysed. The literature search yielded published data on various procedures in digestive surgery. Most of the available high-quality evidence was for gastric and colorectal resections. Resection of the esophagus, use of staplers in emergency procedures and some initial reports on pancreatic surgery were also retrieved. The evidence from the literature shows that stapler anastomoses take less operative time and are more costly than hand-sewn anastomoses. Regarding the morbidity and leaks rate the staplers give equal or better results when compared with the hand-sewn technique. Nevertheless, proper handling of staplers and experience remain crucial issues if one wants to gain benefits when using these devices.

Navigation in laparoscopy – prototype research platform for improved image‐guided surgery

Abstract: The manipulation of the surgical field in laparoscopic surgery, through small incisions with rigid instruments, reduces free sight, dexterity, and tactile feedback. To help overcome some of these drawbacks, we present a prototype research and development platform, CustusX, for navigation in minimally invasive therapy. The system can also be used for planning and follow-up studies. With this platform we can import and display a range of medical images, also real-time data such as ultrasound and X-ray, during surgery. Tracked surgical tools, such as pointers, video laparoscopes, graspers, and various probes, allow surgeons to interactively control the display of medical images during the procedure. This paper introduces navigation technologies and methods for laparoscopic therapy, and presents our software and hardware research platform. Furthermore, we illustrate the use of the system with examples from two pilots performed during laparoscopic therapy. We also present new developments that are currently being integrated into the system for future use in the operating room. Our initial results from pilot studies using this technology with preoperative images and guidance in the retroperitoneum during laparoscopy are promising. Finally, we shortly describe an ongoing multicenter study using this surgical navigation system platform.

Stem cell‐based therapy in gastroenterology and hepatology

Abstract: Protagonists of a new scientific era, stem cells are promising tools on which regenerative medicine relies for the treatment of human pathologies. Stem cells can be obtained from various sources, including embryos, fetal tissues, umbilical cord blood, and also terminally differentiated organs. Once forced to expand and differentiate into functional progenies, stem cells may become suitable for cell replacement and tissue engineering. The manipulation and/or stimulation of adult stem cells seems to be particularly promising, as it could improve the endogenous regenerative potential without risks of rejection and overcome the ethical and political issues related to embryonic stem cell research. Stem cells are already leaving the bench and reaching the bedside, despite an incomplete knowledge of the genetic control program driving their fate and plasticity. In gastroenterology and hepatology, the first attempts to translate stem cell basic research into novel therapeutic strategies have been made for the tre...

Adult mesenchymal stromal stem cells for therapeutic applications.

Abstract: Mesenchymal stromal stem cells (MSC) can be found in almost any adult organ They can be isolated and expanded within several weeks up to hundreds of millions of cells The cell isolation based on the surface antigen expression may significantly enrich for the desired cell population and reduce the time required for cell expansion MSC display a unique molecular signature which clearly discriminates them from other stem cell types MSC can be differentiated into the cells of several lineages Additionally, the unique biological properties of MSC are mediated by strong immunomodulatory activity and by paracrine mechanisms Potential therapeutic applications of the cells require clinically compliant protocols for cell isolation and expansion The therapeutic utility of MSC has been evaluated and found to be useful in several pre‐clinical animal models as well as in clinical trials

Submucosal endoscopy with mucosal flap safety valve (SEMF) technique: a safe access method into the peritoneal cavity and mediastinum.

Abstract: Natural orifice translumenal endoscopic surgery (NOTES) is a unique emerging surgical concept expanding flexible endoscopy beyond the gut wall. The methods and technology growing from this concept may minimize trauma from surgical access to the peritoneal cavity by completely eliminating body surface incisions. Our colleagues at the Mayo Clinic have explored, over several years, the concept of using the submucosa as a working space for endoscopic interventions, such as resection of mucosal neoplasias and submucosal tumors, as well as for the acquisition of muscular tissue for etiologic analysis of motility disorders. The submucosal space can also be utilized as a protective tunnel preventing peritoneal soiling by using the free overlying mucosa, as a sealant flap, and permitting a safer offset entry into the peritoneal and thoracic cavities for NOTES. In the SEMF technique, the submucosal space is mechanically created by balloon dissection facilitated by either high-pressure CO2 gas injection or chemically 'softening' the submucosal connective tissues. This article reviews and describes SEMF in detail along with applications involving in vivo porcine models.

The mechatronic support system "HVSPS" and the way to NOTES.

Abstract: Since the publication of the first paper on NOTES, a dramatic increase of activities in this new surgical field is to be observed. However, a "pure" NOTES operation does not yet exist. Only NOTES-like operations have been proposed so far. One of the essential barriers is the limited intraoperative performance due to the lack of suitable mechatronic platforms. Some solutions have already been suggested but they are still far from having any practical impact upon the development of more advanced NOTES procedures. The "Highly Versatile Single Port System", a two-armed device with two manipulators and a semi-flexible telescope, was developed to overcome these drawbacks. A transsigmoid cholecystectomy on a NOTES simulator (the ELITE) could be accomplished successfully in 75 minutes. We could therefore show that the HVSPS is in principle applicable for such a NOTES procedure. However, before these mechatronic support systems can be used under clinical conditions, required human machine interface and extended intelligence have to be solved.

Instruments for transluminal laparoscopic surgery or "NOTES".

Abstract: The first endoluminal operation ever developed was transanal endoscopic microsurgery (TEM), years before laparoscopic cholecystectomy was first performed. Numerous procedures using its single port system (SPS) have since been done and it is now a well-established technique in colorectal surgery around the world. There are some advantages of SPS over multiple port surgery. In 2005 we expanded on the concept of single port surgery with rigid instruments and started to develop instruments for transvaginal single port laparoscopic surgery. We now describe the instruments and system, which include devices that permit a safe access to the abdominal cavity, optimal endoscopic view and instrument steering and a precision that is not reached by current flexible technologies. The devices have been put to the test in an experimental model of transvaginal cholecystectomy. The potential benefits of the technique and the new instruments are discussed.

Stem cell‐based cellular replacement strategies following traumatic brain injury (TBI)

Abstract: Given the limited capacity of the central nervous system for self-repair, the use of stem cells holds an enormous potential in cell replacement therapy following traumatic brain injury and has thus received a great deal of scientific and public interest in recent years. During the past decade, several stem/progenitor cell types and lines from various sources such as embryonic rodent and human stem cells, immortalized progenitor cells, bone marrow derived cells or even post-mitotic neurons derived from human teratocarcinoma cells have been assessed for their potential to improve neurofunctional and behavioural outcome after transplantation into the experimentally injured brain. A number of studies indicate that cells engrafted into the injured brain can survive and, at least in part, may reverse behavioural dysfunction and histomorphological damage. Although these results emphasized their potential therapeutic role in traumatic brain injury, the detailed mechansim on how stem cells generate their mode of action, e.g. via integration into surviving neuronal circuits, local trophic support, or modification of the local mircoenvironment to enhance endogenous regeneration and potection remain yet to be identified. A review on current pre-clinical knowledge with respect to cellular replacement into the experimentally injured brain is presented.

Exercise‐induced stem cell activation and its implication for cardiovascular and skeletal muscle regeneration

Abstract: A number of publications have provided evidence that exercise and physical activity are linked to the activation, mobilization, and differentiation of various types of stem cells. Exercise may improve organ regeneration and function. This review summarizes mechanisms by which exercise contributes to stem cell‐induced regeneration in the cardiovascular and the skeletal muscle system. In addition, it discusses whether exercise may improve and support stem cell transplantation in situations of cardiovascular disease or muscular dystrophy.

Technical feasibility of totally natural orifice cholecystectomy in a swine model

Abstract: The goal of this study was to evaluate the feasibility of totally NOTES performing a cholecystectomy without laparoscopic assistance. A gastroscope was used through a transvaginal access in five acute female pigs. An incision of 2 cm was created in the vagina and pneumoperitoneum was obtained with a Veress needle. The gallbladder was located in the abdominal cavity using endoscopic transillumination for spatial orientation. After the abdominal suspension of the gallbladder the cholecystectomy was completed with the NOTES technique in four animals without complications. In one animal we had technical problems and the procedure was stopped. The mean operative time was 110 minutes. The transvaginal approach provides complete abdominal exploration and both the cystic duct and artery were identified, clipped, and transected. After dissection the gallbladder was removed through the vagina. Our results showed that completely transvaginal NOTES cholecystectomy is a feasible technique performed only with a flexible endoscope.

Circular 'superelastic' compression anastomosis: from the animal lab to clinical practice.

Abstract: The recent development of a compression device using shape memory Nitinol technology to create an end-to-end anastomosis has renewed the interest in sutureless anastomotic techniques. A phase II, prospective open label clinical trial was started in May 2007 to evaluate the feasibility and safety of this new anastomotic device. Fourty patients who need left colectomy or high anterior resection for either diverticular disease or adenocarcinoma will be recruited in two academic hospitals (Uppsala,Sweden and Leuven, Belgium). Clinical leakage is the primary endpoint. Only preliminary results are available to date as the recruitment is ongoing. The median age of the first ten patients is 57.5 years (44-72). No anastomotic leakage occurred. The median hospital stay was 4.0 days. Only three patients noticed the passage of the ring through the anal canal. By three weeks no ring was sustained in the gastrointestinal tract as was objectified by plain X-ray. First clinical use of this new anastomotic device seems promising. Final results for the total phase II trial are awaited. A prospective randomized trial to compare the efficacy of the EndoCar 28 with conventional stapling should be the next step.

A newly designed magnet-retracting forceps for laparoscopic cholecystectomy in a swine model.

Abstract: We designed a method for remote-controlled endoscopic surgery using magnet-retracting forceps. To evaluate the feasibility of this technique, laparoscopic cholecystectomy was attempted in a swine model. This method takes advantage of the attractive force between two magnets, one inserted into the peritoneal cavity and the other located outside the abdominal wall. An intra-peritoneal magnet was fixed to the fundus of the gallbladder using an endovascular clip. Laparoscopic cholecystectomy was accomplished by magnetic retraction of the gallbladder. This magnet-retracting forceps provided port-less access to the abdominal cavity. Since the direction and range of retraction were unrestricted by the location of access-ports fixed on the abdominal wall, surgery could be less invasive. In addition, this procedure provided surgeons with excellent endoscopic views, as retraction force was supplied without any shaft device in the abdomen. This operation system using magnetic retraction appears promising.

Tumor thermal ablation therapy using alkali metals as powerful self-heating seeds.

Abstract: The aim of this study is to demonstrate a new tumor thermal ablation therapy, which might lead to a highly economic, safe and efficient heating of target tissues. The alkali metals, usually seen as hazard mediums in daily life, were proposed for the first time as perfect self-heating seeds which can significantly raise the temperature of the tumor tissues. Owing to the tremendous heat released at only the target site during reaction between the metal and the intrinsically existing wet environment of the biological body, the tumor tissues can be efficiently ablated without causing thermal damage to the surrounding healthy tissues. Several conceptual experiments were performed to demonstrate the new thermal ablation principle. Mammary adenocarcinoma cells in culture were found to be quickly destroyed due to the thermal and chemical effects induced by the alkali metal. Further, a significant temperature increase by a magnitude of > 40 degrees C or even combustion has been found easily available at the target site; this temperature increase produces a sufficiently large coagulation and necrosis area within selected areas either for in vitro or in vivo tests. The unique merit of the present thermal ablation therapy is that its remaining reactant can be absorbed by the tissue itself without causing any damage. This study opens possibilities of using the alkali metals to thermally ablate the target tumor in future clinical applications.

New concepts for a compression anastomosis: superelastic clips and rings.

Abstract: Gastrointestinal anastomosis is a crucial step in many operative procedures, and responsible for a major portion of early and late post‐operative complications. In order to improve on the results of current tools to perform an anastomosis, such as sutures and staplers, new concepts are being developed. One of these concepts is compression anastomosis. Compression anastomosis has been tried in the past but did not become popular mostly because of technical reasons. Recently, trials to accomplish compression anastomosis using Nitinol devices were conducted.Two devices were made and tested in the past three years: A side‐to‐side device and an end‐to‐end device. The common principle in both devices is the compression of two bowel loops through the constant pressure of a Nitinol device, thus producing a dual process of necrosis and healing until the lumens of both bowels fuse, and the device falls into the lumen and is excreted. Both devices have been tested in animals and humans, with encouraging results. In ...

Bipolar radiofrequency ablation: is the shape of the coagulation volume different in comparison to monopolar RF-ablation using variable active tip lengths?

Abstract: We investigated the differences between bipolar and monopolar radiofrequency (RF)-ablation devices regarding the shape and volume of the induced coagulation zone. RF-ablations were performed in freshly excised porcine liver. For bipolar RF-ablation needle electrodes with 9, 20 and 30 mm active tip lengths were used. Each electrode was used ten times in accordance with the vendor's recommended ablation protocol. For monopolar RF-ablation a needle electrode was also used. Active tip length was modified by removing parts of the insulation resulting in tips lengths of 9, 20 and 30 mm. The lesion shape and volume were calculated and compared. In general, lesion size increased with increasing active tip length. At 9 mm tip length lesion volumes were significantly larger using the monopolar RF-system (0.598+/-0.094 cm(3) vs. 0.139+/-0.028 cm(3)). At 20 and 30 mm tip length bipolar RF-ablation created significantly larger areas of necrosis (20 mm: 3.498+/-0.605 cm(3) vs. 2.569+/-0,620 cm(3), 30 mm: 7.441+/-906 cm(3) vs. 3.317+/-0.737 cm(3)). Using the probes with 9 mm, active length areas of necrosis induced by the monopolar system are more spherical, whereas with 20 and 30 mm active tip length the bipolar system creates more spherical lesions. The proper combination of RF-system and electrode length allows to individually adapt the shape and volume of the generated coagulation necrosis to the target lesion.

Laparoscopic splenectomy with a vessel sealing device.

Abstract: When compared with open splenectomy, laparoscopic splenectomy was associated with fewer complications, however, with more hemorrhagic complications. Furthermore, the mean operative time for laparoscopy was significantly longer than for the open procedure. Vessel sealing systems are represented as decreasing operative time and blood loss in several surgical procedures. The aim of this study is to evaluate the blood loss and operating time of laparoscopic splenectomy with a vessel sealing system. We evaluated 19 laparoscopic splenectomies with a vessel sealing device, particularly focusing on operative blood loss and operating time. Patients were operated in the right lateral decubitus position usually with three ports. In all cases, dissection of the spleen and sealing of hilar vessels and short gastric vessels were performed with a vessel sealing system. No clips, sutures, or monopolar–bipolar diathermy were used. Mean operative blood loss was 88ml (range 20–400 ml) and mean operative time was 107 minutes...

Development of a micro-robot for endoscopes based on wireless power transfer.

Abstract: This paper develops a new prototype of a wireless micro-robot system for endoscopes. The micro-robot we have fabricated and tested is able to propel itself in the intestine of pig. Its autonomous manner is earthworm-like and driven by linear actuators based on a DC motor. Unlike with conventional micro-robot endoscopes, that wireless module is used for communicating and power transfer. The experimental results show that the driving force of the linear actuator can reach up to 2.55 N and the stable supplying power is up to 480 mW DC power for the receiving coil in the proposed system, which all fulfill the need of the micro-robot system. The micro-robot can creep reliably in the small and large intestine of a pig. The video communication module embedded in the head of the micro-robot can capture the inner picture of the intestine and broadcast it to PC in real-time.

Fatal gas embolism during ureteroscopic holmium: yttrium- aluminium-garnet laser lithotripsy under spinal anesthesia - a case report

Abstract: Ureteroscopic holmium: yttrium-aluminium-garnet (Ho:YAG) laser lithotripsy is an excellent treatment modality, especially for a large impacted ureteral stone. The treatment is efficient and safe. It helps surgeons to carry out a minimally invasive lithotripsy instead of an open surgery in patients with ureteral calculi. Here, we present the first report of a fatal gas embolism that occurred during ureteroscopic Ho:YAG laser lithotripsy under spinal anesthesia. When this complication occurs, the correct crisis resolution protocols, such as prevention of further air entry, reduction in the volume of air entrained, well-hydration, and rapid initiation of cardiopulmonary resuscitation with administering inotropic drugs, are highly effective in the critical period.

Novel technologies for natural orifice surgery: an overview.

Abstract: Natural Orifice Surgery (NOS) is now being elaborated with the aim to make abdominal surgery simpler and safer. The existing natural openings of the body are used for introduction of surgical instruments and thus to perform surgical procedures while avoiding to penetrate the abdominal wall. Actually, the transvaginal and transgastric approaches are the common routes used for NOS applications in humans. The transvaginal approach does not necessitate any sophisticated devices for opening and closure of the posterior colpotomy, thus being easy for the surgeon and safe for the patient. In contrast, the problem of transluminal access and closure represents significant obstacles in the transgastric approach and is still unsolved. In order to achieve this goal, various surgical prototype devices have been developed. This article aims to give an overview on the current status of techniques and technologies that are being developed and applied in conjunction with NOS procedures.

Percutaneous aortic valve replacement: a novel design of the delivery and deployment system.

Abstract: The frontier of percutaneous aortic valve replacement is challenged by hemodynamic and anatomic obstacles in the precise positioning of the device. With vital structures such as the mitral valve apparatus and the coronary ostia on either side, the margin of error is only within a few millimeters in the placement of the percutaneous aortic valve. An optimal system of delivery and deployment of this device has yet to be made commercially available. A novel design of a system of delivery and deployment of currently investigational aortic valved-stent is presented. In the proposed procedural and equipment strategy, the local hemodynamic and anatomic conditions are controlled to allow for precise placement of the device, and overall improvement of the patient stability and safety can be made possible. Continued efforts in innovative designs in this area are encouraged such that the percutaneous valvular intervention can become mainstay as it has in the arena of percutaneous coronary intervention.

New developments for endoscopic hollow organ closure in prospective of NOTES

Abstract: The closure of the gastrotomy in Natural Orifice Endoscopic Surgery (NOTES) is a prerequisite for transgastric endoscopic procedures in the abdominal cavity. Different techniques have been proposed and are under experimental or early clinical investigation. These include the use of conventional endoscopic clips, newly designed clips or T‐BARS in different shapes or more complicated devices such as linear endoscopic staplers and septal occluders, originally used for the treatment of cardiac septal defects.We describe here a further alternative of endoscopic organ closure in NOTES, using the OTSC, a novel type of clip attached to the tip of the endoscope. The OTSC clip as a CE‐marked device is widely used clinically for various endoscopic procedures, such as the treatment of gastrointestinal bleeding and iatrogenic defects of the digestive tract, e.g. colonic perforations after endoscopic interventions. Now an enlarged version of the OTSC clip can be applied for the closure of transluminal access to the abd...

A new minimally invasive method for the transtubal, microendoscopic application of fluids to the middle ear.

Abstract: The Eustachian (or auditory) tube is of central importance for the regulation of ambient air pressure changes within the middle ear spaces. Dysfunction of the Eustachian tube usually leads to chronic inflammatory changes of the middle ear. The aim of the present feasibility study was to investigate an alternative, minimally invasive approach for the application of fluids to the middle ear via the Eustachian tube. This so-called transtubal application (TTA) was conducted in a prospective, non-randomized study with a total of ten subjects. The TTA approach consisted of placing a microendoscope within the Eustachian tube under local anaesthesia via its epipharyngeal opening. Subsequently, fluids were applied through an additional working channel after microendoscopic evaluation. Therefore the subjects were positioned supine-laterally and had to swallow actively. The successful fluid application into the middle ear was evidenced by microendoscopy of the tympanic membrane (visualization of the fluid level). In all cases, a successful application could be evidenced. Side effects (e.g. pain, mucosal injuries, microbleedings) were not observed. This new technique (TTA) offers the opportunity of a minimally invasive approach to treat tubal dysfunction and possibly other middle ear diseases by local fluid and/or drug application.

Stem cells and nuclear reprogramming.

Abstract: Derivation of human embryonic stem (ES) cells from preimplantation embryos ten years ago raised great hopes that they may be an excellent source of cells for cell replacement therapy. However, serious ethical concerns and the risk of immune rejection of allotransplanted cells have hindered the translation of ES cell‐based therapies into the clinic. In an attempt to circumvent these barriers, a number of methods have been developed for converting adult somatic cells into a pluripotent state from which ethically acceptable patient‐specific mature cells of interest could be derived. These efforts, backed by advances in elucidating the molecular basis of pluripotency, have culminated in successful reprogramming of fibroblasts into ES cell‐like cells, termed induced pluripotent stem (iPS) cells, by ectopic expression of only a handful of “stemness” factors. iPS cells possess morphological, molecular and developmental features of conventional blastocyst‐derived ES cells and have the potential to serve as a sour...

Microwave ablation with cooled-tip electrode for liver cancer: an analysis of 160 cases.

Abstract: A novel microwave electrode with a cooled tip (FORSEA MTC-3 type, China) was devised to better enable microwave ablation of liver cancers. The efficacy of this technology was evaluated. The records of 160 patients (97 with hepatoma, 63 with metastatic cancer of the liver) who had undergone microwave ablation with this new device were reviewed. One-year survival in 86 patients whose follow-up had been more than one year was determined. Pre-operative and post-operative contrast-enhanced CT scans were performed to assess completion of therapy and the presence or absence of recurrent tumor. For patients with hepatoma, serum alpha-fetoprotein (AFP) levels were evaluated pre-operatively and, if elevated, post-operatively. A median two (range one to five) applications were required per session. All patients exhibited initial radiographic resolution of their lesions after therapy. The ablated areas were not enhanced in any phases of contrast CT scan. Eight patients required a second microwave therapy for recurrent tumor; two patients required a third treatment. Twenty-five patients with hepatoma had elevated AFP (104.2+/-22.5 ng/ml), which, after microwave ablation, recovered to normal or almost normal (24.6+/-3.6 ng/ml) (t = 2.1, p<0.05). There were no post-operative deaths. Complications included fever in three of four patients, successfully treated with indomethacin, elevated transaminases in four of five patients, requiring no treatment except for those with pre-operative ascites (who were dialyzed), pleural effusions in fourteen patients, only one of whom required drainage, and obstructive jaundice requiring drainage in two patients. The one-year survival rate was 91.9%. Microwave ablation with this novel cooled-tip electrode is safe, minimally invasive and effective. The tool may greatly expand the fraction of patients with liver cancer who might be candidates for microwave ablation.

Minimally invasive adrenalectomy for incidentally discovered cavernous hemangioma.

Abstract: Cavernous hemangiomas are rare, benign, non-functioning neoplastic lesions that often involve liver and skin. Hemangiomas of the adrenal gland are very uncommon, and usually found accidentally in otherwise asymptomatic patients. This paper reports the only case of a large cavernous hemangioma removed with transperitoneal laparoscopic adrenalectomy and reviews the literature.

Total laparoscopic hysterectomy (TLH) versus coagulation of uterine arteries (CUA) at their origin plus total laparoscopic hysterectomy (TLH) for the management of myoma and adenomyosis.

Abstract: We tried to evaluate the relative feasibility, surgical duration and complications of total laparoscopic hysterectomy (TLH) versus coagulation of uterine arteries at their origin (CUA) plus total laparoscopic hysterectomy for the management of myoma and adenomyosis, and to compare the estimated blood loss for both procedures. A total of 123 patients underwent TLH or CUA plus TLH for the treatment of symptomatic myoma and adenomyosis. Sixty-four women underwent TLH, whilst 68 women underwent coagulation of uterine arteries at their origin plus TLH. The mean weight and volume of the uterus as determined following TLH was 288.1+/-102.4 gm (range 182.1 approximately 396.2 gm.) and 451+/-340.6 cm(3) (range 107.4 approximately 792), respectively. The mean weight of the uterus following CUA plus TLH was 269.1+/-151.7 gm (range 215.8 approximately 430.1) whilst the mean uterine volume was 472.7+/-377.8 cm(3) (range 93.7 approximately 851.2). No significant differences with respect to surgical duration (95 vs. 96.5 minutes TLH vs. CUA + TLH; p>0.05), blood loss (177.2+/-80.1 ml for TLH and 154.9+/-30.21 ml for CUA+TLH; p>0.05) and mean+/-SD preoperative (12.05+/-1.70 gm/dl for TLH and 12.14+/-1.38 gm/dl for CUA+TLH; p>0.05) and post-operative hemoglobin level (11+/-1.03 for TLH and 11+/-1.49 for CUA + TLH; p>0.05) were observed between the two study groups. The blood loss for TLH is comparable to that for the CUA plus TLH procedure.